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APPLICATION FOR SANITATION PERMIT Permit No. .- _�_ in (Complete Quphcete) Date Issued __r°I_H/ Applicaa-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordi 'ante No. 549. JOB ADDRESS AND LOCATION-------'_5-�-Q__- ( �� r A �^�-� --------------- Owner's Name---------------•�=7j'le-S---••------- -� "�� -� ----------- Phone- . �-- - - . •U Address------------------------•-----------••------- -------- ----�- - -- - ..._ 'a- ---------------•-------------------- ----------------------------------- Contractor's Name-------------____ ------------------------------------------------------ Ph( n .-- _ � Installation will serve: Residence i3' Apartment House ❑ Commercial E] Trai er Court E] Motel El Other El n Number of living units: -_I____ Number of bedrooms Number of baths ---- Lot size __-- Water Supply: Public system Community system E] Private ❑ Depth to Water Table*ft. Character of soil to a depth of 3 feet: Sand [�•' Gravel ❑ Sandy Loam E❑ Clay Loam ❑ Clay ❑ Adobe 2---Hardpan ❑ 'r Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ rll A _.r TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) ep is`Ta k:, Distance from nearest well_______________ Distance from foundation____._______.-___. Material----------------__..______- --------- --------- No. of compartments ---Size------ ----------------------Liquid depth------------------------Capacity F' Distance from nearest well..-_______------Distance from foundation--------------------Distance to nearest lot line________..______. Number of lines-----------------------------------Length of each line----------------------- :-----.Width of trench------------------------- ---------- ype of filter motorial--------- ------ -------Depth of filfer material-----------------------Total length--------------------•----_-----_•---_--•-- Seepage f: Distance to nearest well - - Distan e from foundation_-4.41K-��_ Distant to nearest lot line----- ------of pits______--------------Lining material ---_--Size: Diameter__..-_,5 Depth_ !-_- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining materia!__.-_-____.._.-__..._._____-_______. I ❑ Size: Diameter------------ Depth ---- y ----------------------Liquid Capacity--------------------------gals. } Privy: Distance from-nearest well--------------------------------------- -- { ._.;.,._Distance from nearest building____' ___________________ \\� � Distance to nearest lot line_________ ;. ------------------ V} Remodeling and/or repairing fdescribe)________________________ -------------------------------------------------------•---------------------------------- --------------------------------------- --------------------------- -----•---•------------------------------------------------------- --------------------------------•-------------•----------------=•--:-------------•------------------------•---------------------------------- I herebypafela that I have prepared,this application and that the work will be done in accordance with San Joaquin County ordinances, Ss, and r les and reguI fi sof the San Joaquin Local Health Districf. - --L(Signed)-------••- -�.'.i91 -------------- ------------------------ 4 By:---------------•------------------- Title .,- Contractor) - - ------- -- -------•-----------{ ) �s�-�. _c� or---- • ----------------------- (Plot plan, showing size of lot, location of system in relat' to wells, buil ' gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____________ __ __ ____ F___-- DATE.-__._� RElV --------------------------------- IEWED BY-------------------------- --- ------------- ------ ---- --------------------------------------------- '----------- DATE--- 4 BUILDING PERMIT ISSUED----- DATE------------ ----- -•------------- -------------•----- Aterations and/or recommendations:.______--------- ----- P --------------------•-------- ---------••---------------------------------------•---- ------------------ -- -----•-----------------••------- ----------------• -----. -----------•--- 43� ----------------•--------•----•-----•----•-------•------ ------------------------------- -------------------•----------------------------------------••-------------------- --•-•-------------------•------------------•------ ---------------------- ----------------------------- ----------------- -------------------------------- -----------------•---- --- --------------------- FINAL INSPECTION BY---------- --- - ------------- Date,-4-_r------- SAN -.-� -' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca,.California Tracy, California ES-9-2M 145446 ATWOOD 12-54